Frequency and factors associated with increased small intestinal permeability in patients with portal hypertension

Abstract

Aim: Cirrhosis with portal hypertension (PHT) may be associated with increased small intestinal permeability (SIP), predisposing to malnutrition and bacterial translocation causing septicaemia, endotoxaemia and spontaneous bacterial peritonitis. However, data on SIP in extrahepatic portal venous obstruction (EHPVO), in which PHT occurs without hepatic dysfunction, are scanty. Such studies would help to know the effect of PHT on SIP independent of hepatic dysfunction; hence, we undertook this study. Methods: A total of 96 patients with PHT (cirrhosis 71, EHPVO 25) underwent evaluation of SIP using urinary lactulose/mannitol excretion ratio over 6 hours after oral administration of 15 mL (10 g) lactulose and 5 g mannitol using 1H-NMR spectroscopy by a method described by us previously. Results: Gender of patients with EHPVO and cirrhosis was comparable but patients with EHPVO were younger in age. The causes of cirrhosis were cryptogenic (n=22), alcohol (n=20), post-viral (n=21) and others (n=8). Twenty-seven (38%) patients with cirrhosis had ascites. Abnormal SIP was detected in 47 (49%) patients (40/71, 56% with cirrhosis vs. 7/25, 28% with EHPVO, p=0.01). Patients with cirrhosis had a higher urinary lactulose/mannitol excretion ratio than those with EHPVO (0.09, range 0-0.87 mmol vs. 0.05, 0-0.19 mmol; p=0.008). Patients with abnormal SIP had a higher Child score, and more often had cirrhosis than EHPVO, ascites and deranged liver function. On multivariate analysis, presence of cirrhosis, ascites, high serum bilirubin level and prothrombin time were associated with abnormal SIP. Conclusions: Cirrhosis was associated with abnormal SIP, which was related to liver dysfunction. However, SIP was normal in patients with EHPVO.

Duodenal Morphometry and Small Bowel Permeability in Children With Portal Hypertension

“…Lymphatic channel dilatations and protein losing enteropathy has been described in pediatric (32) as well as adult (33) patients. Therefore, a significant increase in the lactulose-to-mannitol ratio was observed in cirrhotics (25). In our study, blood capillaries were dilated; however, none had lymphatic channels dilatation.…”

“…Different sugars are used to study the SIP of different sites and routes. We have used NMR spectroscopy because this technique is available to us and the technique has been standardized at our institute (24,25). Rather they are absorbed through paracellular pores (pore size 8-13 Å , with surface area of 0.01%-0.1% of total absorptive epithelium).…”

Curcumin Protects Against Intestinal Origin Endotoxemia in Rat Liver Cirrhosis by Targeting PCSK9

“…It is well recognized that at the end stage of liver cirrhosis, and with the increased intestinal permeability, portal vein LPS concentration increases (Goyal and others ). The liver monocyte‐microphages, mainly Kupffer cells, were activated through LPS receptors such as CD14 and TLR4 (Feng and others ; Li and others ); consequently, cytokines were secreted, leading to more serious innate inflammation and systemic condition deterioration (El Kasmi and others ).…”

“…Endotoxin mainly consists of lipopolysaccharide (LPS) in Gram‐negative bacteria cell walls. Intestinal motility reduction and intestinal barrier interruption are the consequence of decompensate liver cirrhosis; increased intestinal permeability results in bacterial translocation before a great amount of LPS enters the portal‐vein though the intestine‐liver axis (Mehal ; Goyal and others ; Chassaing and others ).…”